Your Questions Answered - February 2012 (Steroids and Osteoporosis)
I’m 67 and after a lifetime of good health developed asthma in my fifties. I use a variety of inhalers including steroids which I use at least three times a day and if my asthma’s bad twice that much or more. I’ve read that steroids can increase the risk of osteoporosis and bone fractures and I’m really alarmed now as I’ve seen the devastation this illness causes in my sister-in-law. What should I be doing to protect my bones?
This is a very sensible question but I can put your mind at rest by telling you that inhaled steroids are a very low risk for the development of osteoporosis. The situation is very different though if you get frequent severe attacks and have to take steroid tablets. One in 11 men develops osteoporosis and the risk increases with age so you must act now to protect your bones. The nutritional status of older people is much more likely to be below the optimum level as the digestive processes become less efficient, appetite declines and the bother of shopping and preparing proper meals becomes a bit of a chore. It’s all too easy to slip into lazy and unhealthy eating habits which you cannot afford to do.
The main nutrients you need for your bones are calcium and vitamin D, the best sources of which are milk, cheese, sesame seeds, tofu, dried figs, yoghurt, muesli, chickpeas and green vegetables. Vitamin D is found in abundance in all oily fish – salmon, herrings, pilchards, mackerel, trout, fresh tuna and eggs. One of the richest sources is canned sardines which are a double bonus because if you eat the bones they also contain a large amount of calcium. Mashed up with some cider vinegar, a dash of Worcester sauce and eaten on hot toast with a fresh tomato you get the extra vitamin C which improves the calcium absorption.
Your skin manufactures vitamin D from sunlight so in spite of all the skin cancer scares get your arms and face, and where possible your legs too, exposed to sunlight during the morning and late afternoon for at least 10 or 15 minutes a day to boost your stores.
Avoid canned fizzy drinks, excessive amounts of salt, too much alcohol, wheat bran and bran-based cereals as these all prevent calcium from being absorbed. Most importantly, you must take regular weight bearing exercise as this encourages your bones to maintain their strength and density. Twenty minutes a day on your feet, walking, gardening, doing DIY jobs or being active in any way is all you need.
At your age I would strongly recommend a calcium and vitamin D supplement which will give you at least 1000 mg of calcium – preferably calcium citrate which is better absorbed than calcium carbonate – and 10 micrograms of vitamin D. Whatever you do you mustn’t stop using your inhalers.
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